Immunotherapy of Uveitis
George S. Eisenbarth in Immunotherapy of Diabetes and Selected Autoimmune Diseases, 2019
Although intraocular inflammation was known to the ancients, it remains a diagnostic and therapeutic challenge to the ophthalmologist. Uveitis is the term commonly used to denote any type of inflammation within the internal components of the eye. The term strictly used denotes inflammation of the uveal tract which encompasses the iris, ciliary body, and the choroid (Figure 1). It is useful to study these diseases according to anatomical localization. The terms anterior, intermediate, and posterior uveitis appropriately depict the uveitic syndromes encountered by the clinician. Uveitis is usually classified into infectious or nonin-fectious, but the causes of the latter are usually unknown. Diagnosis is often based on pattern recognition and not on the actual isolation of a causative agent. There is substantial morbidity associated with certain uveitic syndromes, and 10% of serious visual handicap in the United States is attributed to intraocular inflammation.1
Uveitis
Ching-Yu Cheng, Tien Yin Wong in Ophthalmic Epidemiology, 2022
More than 60 diseases are associated with or directly cause the inflammation of uveal tissue.13 These etiologies can be categorized into three groups: infectious, noninfectious, and idiopathic. Infectious uveitis refers to intraocular inflammation caused mainly by pathogens, which can be identified intraocularly. Pathogens, including viruses, bacteria, parasites, and mycobacteria, may directly infect intraocular tissues or trigger host immune responses, leading to various degrees of uveal inflammation. Noninfectious uveitis results from the immune-mediated inflammation associated with systemic or intraocular rheumatological diseases. Systemic rheumatological disorders such as seronegative spondyloarthropathy, Behçet’s disease, sarcoidosis, Vogt–Koyanagi–Harada (VKH) disease, juvenile idiopathic arthritis, and multiple sclerosis have been reported to be strongly associated with uveitis. In several situations, the autoimmune or autoinflammatory response can occur with specific presentations that are all restricted to the eyes, such as multifocal choroiditis, birdshot chorioretinopathy, serpiginous choroiditis, and sympathetic ophthalmia (Table 16.1). Exogenous stimulation such as trauma to the eyeball, intraocular surgical procedures, and medications may also induce uveitis. Uveitis cases in which the exact etiologies cannot be identified on the basis of recent knowledge are categorized under “idiopathic uveitis” or “uveitis with unidentified etiology.” Idiopathic uveitis is more commonly noninfectious, but could occasionally be infectious with unidentifiable pathogens.
Eczema and the Eye
Donald Rudikoff, Steven R. Cohen, Noah Scheinfeld in Atopic Dermatitis and Eczematous Disorders, 2014
Uveitis is an inflammation of the uveal tract, which includes the iris, ciliary body, and choroid. Uveitis can be idiopathic, or be caused by infectious, autoimmune, or granulomatous disease. Symptoms vary and depend on site and severity of inflammation. Anterior disease involving the iris and ciliary body usually presents with pain, redness, and photophobia, whereas posterior disease involving the choroid produces floaters and decreased vision. Potential complications are cataract, ocular neovascularization, and visual loss. Uveitis in the setting of atopic dermatitis often represents a complication of some other ocular abnormality, particularly a retinal tear. It has been hypothesized that inflammation may result from release of antigen after such a tear (Lim and Chee 2004). Uveitis alone in atopic dermatitis usually takes the form of anterior uveitis (Singh and Mathur 1968, Amer et al. 2007).
Comparison of pediatric patients with idiopathic uveitis, and uveitis due to juvenile idiopathic arthritis and Behçet’s disease
Published in Postgraduate Medicine, 2023
Deniz Gezgin Yıldırım, Murat Hasanreisoğlu, Sevcan A. Bakkaloğlu
Uveitis, inflammation of the uvea comprising the iris, ciliary body, and choroid, can lead to visual loss when left untreated [1]. Uveitis is classified by the layer of the inflammation including anterior uveitis (iris and ciliary body), intermediate uveitis (vitreous), posterior uveitis (choroid and retina), and pan-uveitis (all layers of the uvea) [2]. Uveitis is a rare disease and approximately 10–15% of patients present in the childhood period. The main symptoms of uveitis are pain, redness, excessive tearing, photophobia, and blurred vision. Complications of uveitis are more common in children than those in adults because of the delayed diagnosis due to more insidious course and less self-expression in young children [3]. Topical corticosteroids are the initial treatment in anterior uveitis patients. Systemic corticosteroids and/or disease-modifying anti-rheumatic drugs (DMARDs) are prescribed to patients with posterior segment involvement and who do not get into remission with topical corticosteroids. In recent years, biological therapies have provided a significant benefit for uveitis patients who are unresponsive to traditional therapies [4].
Perspectives for immunotherapy in noninfectious immune mediated uveitis
Published in Expert Review of Clinical Immunology, 2021
Sara Touhami, Julie Gueudry, Mathilde Leclercq, Valérie Touitou, Amine Ghembaza, Marie Hélène Errera, David Saadoun, Bahram Bodaghi
Uveitis is a generic term that encompasses various types of intraocular inflammation. It literally refers to any process involving an inflammation of the uveal tissue that includes the iris, ciliary body, and the choroid. Inflammation can also affect the adjacent tissues such as the retina, retinal vessels, and optic nerve. Uveitis can be infectious or noninfectious. Noninfectious uveitis (NIU) represents up to 50% of all uveitis causes in the industrialized world, whereas the infectious causes are more prevalent in developing countries [1]. Uveitis can also be subdivided into anterior, intermediate, posterior uveitis, and panuveitis depending on the location of the initial inflammatory reaction (Table 1). This categorization is important because it defines both the type of therapy and means of administration. With a prevalence of 38–284/100,000 [2], uveitis is one of the leading causes of visual loss among the working-age population, causing a real burden to society. The prognosis depends on the development of complications such as cataracts, glaucoma, macular edema, or retinal detachment. Therefore, prompt and appropriate management of intraocular inflammation is of paramount importance.
Current standardized therapeutic approach for uveitis in Japan
Published in Immunological Medicine, 2019
Kazuichi Maruyama
Uveitis cases are frequently encountered in medical practice. In Japan, as in the United States, a step wise approach to its treatment is commonly employed [3]. Most cases of uveitis are treated with topical steroid treatment, more particularly with eye drops. However, some patients do not respond to topical treatment, in which case they are referred to hospitals for further investigation and treatment. Especially in severe Behçet disease, Japanese ophthalmologists move directly to biological drugs such as infliximab [3]. In the hospital, these patients undergo clinical tests such as blood tests and chest X-rays in order to investigate the cause of uveitis. One of the most important factors to consider when treating uveitis is to determine whether the underlying cause is an infection, as this will determine the course of treatment. For example, in endophthalmitis or other infectious uveitis, steroid monotherapy or other immunosuppressive treatments can promote disease progression. Moreover, excluding malignant lymphoma and optic neuritis is also important to decide the course of uveitis treatment. In summary, an accurate diagnosis is required for effective treatment. Furthermore, treatment must also be decided in consideration of the etiological, anatomical and chronological aspects of each patient.